着力构建医保基金监管长效机制——基于“两试点一示范”的思考

Focus on the Construction of Long-term Mechanism of Medical Insurance Fund Supervision——Thinking Based on the Work of Two Pilot Projects and One Demonstration

2019年,国家医保局启动基金监管方式创新试点、基金监管信用体系建设试点和医保智能监控示范点(简称“两试点一示范”)建设,积极推动形成可推广、可复制的医保基金监管先进经验。本文通过总结部分试点地区经验,分析目前面临的矛盾和困难,对下一步完善医保基金监管长效机制建设提出对策建议。

In 2019,the National Healthcare Security Administration launched two pilot projects on fund supervision mode innovation and credit system construction,and one demonstration of medical insurance intelligent monitoring construction(referred to as two pilot projects and one demonstration),which actively promoted the formation of advanced experience of medical insurance fund supervision that can be popularized and replicated.This paper summarizes some pilot areas'experience,analyzes the contradictions and diffi culties facing at present,and puts forward countermeasures and suggestions for the next step to improve the long-term mechanism construction of medical insurance fund supervision.